Radiation-induced cardiovascular diseases: Is the epidemiologic evidence compatible with the radiobiologic data?

Schultz-Hector, S.; Trott, Klaus-Rüdiger

doi:10.1016/j.ijrobp.2006.08.071

Cited by 368 publications

(312 citation statements)

References 58 publications

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“…The candidate biological mechanisms for the circulatory disease effects of radiation have been recently reviewed [9,28,29]. At high radiotherapeutic doses (>5 Gy), the cell-killing effect on capillaries and endothelial cells plausibly explains effects on the heart and other parts of the circulatory system [29].…”

Section: Discussionmentioning

confidence: 99%

“…At high radiotherapeutic doses (>5 Gy), the cell-killing effect on capillaries and endothelial cells plausibly explains effects on the heart and other parts of the circulatory system [29]. At lower doses (0.5-5 Gy), in humans and in in vivo and in vitro experiments, many inflammatory markers are upregulated long after exposure to radiation, although for exposures less than about 0.5 Gy, the balance shifts toward anti-inflammatory effects [9,28,30], implying that the initiating mechanisms for adverse effects in this dose range would not directly result from inflammation.…”

Section: Discussionmentioning

confidence: 99%

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Circulatory disease mortality in the Massachusetts tuberculosis fluoroscopy cohort study

et al. 2015

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High-dose ionizing radiation is associated with circulatory disease. Risks from lower-dose fractionated exposures, such as from diagnostic radiation procedures, remain unclear. In this study we aimed to ascertain the relationship between fractionated low-to-medium dose radiation exposure and circulatory disease mortality in a cohort of 13,568 tuberculosis patients in Massachusetts, some with fluoroscopy screenings, between 1916 and 1961 and follow-up until the end of 2002. Analysis of mortality was in relation to cumulative thyroid (cerebrovascular) or lung (all other circulatory disease) radiation dose via Poisson regression. Over the full dose range, there was no overall radiation-related excess risk of death from circulatory disease (n = 3221; excess relative risk/Gy -0.023; 95 % CI -0.067, 0.028; p = 0.3574). Risk was somewhat elevated in hypertensive heart disease (n = 89; excess relative risk/Gy 0.357; 95 % CI -0.043, 1.030, p = 0.0907) and slightly decreased in ischemic heart dis-ease (n = 1950; excess relative risk/Gy -0.077; 95 % CI -0.130, -0.012; p = 0.0211). However, under 0.5 Gy, there was a borderline significant increasing trend for all circulatory disease (excess relative risk/Gy 0.345; 95 % CI -0.032, 0.764; p = 0.0743) and for ischemic heart disease (excess relative risk/Gy 0.465; 95 % CI, -0.032, 1.034, p = 0.0682). Pneumolobectomy increased radiation-associated risk (excess relative risk/Gy 0.252; 95 % CI 0.024, 0.579). Fractionation of dose did not modify excess risk. In summary, we found no evidence of radiation-associated excess circulatory death risk overall, but there are indications of excess circulatory death risk at lower doses (<0.5 Gy). Although consistent with other radiation-exposed groups, the indications of higher risk at lower doses are unusual and should be confirmed against other data.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Circulatory disease mortality in the Massachusetts tuberculosis fluoroscopy cohort study

et al. 2015

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“…Clinical importance of radiation‐induced heart disease is well known, and there is growing evidence of a relation between radiotherapy (RT) and cardiovascular events 1, 2, 3, 4. Increased morbidity and mortality rates from cardiovascular damage may lower the survival rates 5.…”

Section: Introductionmentioning

confidence: 99%

“…The pathogenesis of radiation‐induced cardiovascular damage from animal studies have shown microvascular disease causing chronic ischemic heart disease, and macrovascular disease causing development of age‐related atherosclerosis in the coronary arteries 2. There is also new evidence of high‐grade coronary artery stenosis in mid and distal left anterior descending artery (LAD) in hotspot areas for radiation, and a four‐ to seven‐fold increase has been shown 15.…”

Section: Introductionmentioning

confidence: 99%

Monitoring deep inspiration breath hold for left‐sided localized breast cancer radiotherapy with an in‐house developed laser distance meter system

Jensen

Абрамова

Frengen

et al. 2017

J Applied Clin Med Phys

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Deep inspiration breath hold (DIBH) in left‐sided breast cancer radiotherapy is a technique to reduce cardiac and pulmonary doses while maintaining target coverage. This study aims at evaluating an in‐house developed DIBH system. Free‐breathing (FB) and DIBH plans were generated for 22 left‐sided localized breast cancer patients who had radiation therapy (RT) after breast‐conserving surgery. All patients were treated utilizing an in‐house laser distance measuring system. 50 Gy was prescribed, and parameters of interest were target coverage, left anterior descending coronary artery, (LAD) and heart doses. Portal images were acquired and the reproducibility and stability of DIBH treatment were compared to FB. The comparing result shows there is a significant reduction in all LAD and heart dose statistics for DIBH compared to FB plans without compromising the target coverage. The maximum LAD dose was reduced from 43.7 Gy to 29.0 Gy and the volume of the heart receiving >25 Gy was reduced from 3.3% to 1.0% using the in‐house system, both statistically significant. The in‐house system gave a reproducible and stable DIBH treatment where the systematic error ∑, and random error σ, were less than 2.2 mm in all directions, but were not significantly better than at FB. The system was well tolerated and all patients completed their treatment sessions with DIBH.

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“…The currently recommended tolerance dose for the heart was 40 Gy in fractions of 5×2Gy/week if the whole organ is irradiated and even up to 65 Gy in the case of partial exposure [1]. A. Wittig and R. Engenhardt-Cabillic point out that this is not the case nowadays, since epidemiological findings indicate that the heart is one of the most critical dose-limiting organs in radiotherapy [8]. In their review, Wittig and Engenhardt-Cabillic distinguish three groups of individuals experiencing exposure to radiation: 1) Individuals receiving low doses of radiation (<1 Gy).…”

Section: What Are the Pathophysiological Mechanisms Leading To Cardiomentioning

confidence: 99%

Cardiovascular disease in cancer patients… only the tip of the iceberg?

Maisch

2011

Herz

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Radiation-induced cardiovascular diseases: Is the epidemiologic evidence compatible with the radiobiologic data?

Cited by 368 publications

References 58 publications

Circulatory disease mortality in the Massachusetts tuberculosis fluoroscopy cohort study

Circulatory disease mortality in the Massachusetts tuberculosis fluoroscopy cohort study

Monitoring deep inspiration breath hold for left‐sided localized breast cancer radiotherapy with an in‐house developed laser distance meter system

Cardiovascular disease in cancer patients… only the tip of the iceberg?

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